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Infertility: Presented By
Infertility: Presented By
PRESENTED BY:-
Abhishek Yadav
M Sc Nursing 1st Yea
OUTLINE
• Introduction of infertility.
• Definition of infertility.
• Risk factors of infertility.
• Causes of infertility in men & women.
• Types of infertility.
• Diagnosis of infertility.
• Treatment of infertility.
• Counseling for infertility.
• Ethical & legal aspects of ART.
INTRODUCTION OF INFERTILITY
Infertility is a significant social and medical
problem affecting couples world wide.
Infertility refers to an inability to conceive
after having regular unprotected sex.
Average incidence of infertility is about 15%
globally. (varies in different populations ).
Some causes can be detected and treated,
where as others can not:
Unexplained infertility constitutes about 10 % of
all cases.
According to Mayoclinic, USA :-
- 20% cases of infertility are due to a
problem in man.
- 40% to 50% cases are due to women.
- 30% cases are due to problem in both men
& women.
In India , approximately 15% to 20% of couples
are infertile.
DEFINITION OF INFERTILITY
• Infertility is the failure to achieve
a birth ever a 12 months period
of unprotected intercourse.
OR
• Infertility is the inability of a
sexually active non contracepting
couple to achieve pregnancy in
one year.
RISK FACTORS OF INFERTILITY
CAUSES OF INFERTILITY
IN MEN & WOMEN
IN MEN:-
Low sperm count:
- Less than 10 million sperm per ml of
semen.
- Normal count is 20 million sperm per
ml of semen or more.
No sperm:
- Absence of sperms in semen.
Low sperm motility:
- Sperms are immotile, can not swim.
Abnormal sperms:
(Unusual shape , more difficult to move and fertilize
egg)
Its causes are:
- Testicular infections.
- Testicular cancer.
- Testicular surgery.
Continued….
- Overheating testicles.
- Ejaculation disorders (Retrograde ejaculation).
- Variocele (includes varicose vein in scrotum).
- Undescended testicles.
- Hypogonadism (testosterone deficiency).
- Genetic abnormality.
- Mumps (testicular inflammation).
- Hypospadiasis.
- Chlamydia infection
IN WOMEN:-
Ovulation disorders:
- Premature ovarian failure (before age of
40)
- Polycystic ovary syndrome.
- Hyper-prolactinemia (in non pregnant
state)
- Poor egg quality.
Problems in uterus & fallopian tubes:
- Surgery.
- Sub-mucosal fibroids.
- Endometriosis.
- Previous sterilization treatment.
Medications:
- NSAID’S (aspirin & ibuprofen).
- Chemotherapy.
- Radiotherapy.
- Illegal drugs.
TYPES OF INFERTILITY
• Two types of infertility:
– Primary Infertility.
– Secondary Infertility.
1. Primary Infertility:
When a women is unable to ever bear child .
2. Secondary Infertility:
When a women has been pregnant but
failure to achieve live birth after having a live
birth previously.
DIAGNOSIS OF INFERTILITY
TREATMENT FOR INFERTILITY
IN MEN:-
1. Premature ejaculation or Erectile dysfunction:
- Behavioral approaches (giving suggestions).
- or medications.
2. Variocele:
- If there is varicose vein in scrotum, it can be
surgically removed.
3. Blockage of the ejaculatory duct:
- Sperms can be extracted directly from the
testicles and injected into an egg in
laboratory.
4. Retrograde ejaculation:
- Sperms can be taken directly from the
bladder and injected into an egg in
laboratory.
5. Surgery for epididymal blockage:
- A bypass of the blockage can be
performed, called vaso-epididymostomy
(vas deferens is re-connected to
epididymis ).
IN WOMEN:-
1. Ovulation disorder:
Fertility drugs are prescribed ...
a) Clomifine:-
- To encourage ovulation (in case of PCOS,
etc).
b) Metformin:-
- Clients who do not respond to
clomiphine.
- Especially when client with PCOS linked to
insulin resistance.
c) FSH:-
- A hormone produced by pituitary.
- Controls estrogen production by ovaries.
- It stimulate ovaries to mature egg follicle.
- Ex: Gonal-F, Repronex,Follistim,(given S/C)
d) Human Menopausal Gonadotrophin:-
- EX: Bravelle, Repronex, and Menopur (given
I/M or can be S/C).
- Genetically engineered products.
- Contains both FSH & LH.
- In case of absent ovulation due to
pituitary dysfunction.
e) Human Chorionic Gonadotrophin :-
- Given in combination (clomiphine + HMG
+ FSH ).
- It stimulates follicles to ovulate.
- given I/M or S/C.
f) Gn- RH :-
- For women who ovulate premature follicle
during HMG treatment.
- Delivers constant supply of Gn-RH to
pituitary gland , which alters the
production of hormone , that allows
doctor to induce follicle growth with FSH.
-Given by intranasal spray, subcutaneous
injections
g) Bromocriptane:-
- Stimulate ovulation by inhibiting
production of prolactin.
- Prolactin stimulates milk production in
lactating mothers.
- Ex: Parlodel, Cycloset, (given oral or i/v)
INFERTILITY COUNSELING
• Infertility counseling deals with the psycho-
social impact of infertility in terms of :
– Intervention,
– Treatment, and
– After-effects of both successful and unsuccessful
treatments.
• It also involves therapeutic work to help
patient cope with the consequences of
infertility & treatment.
Objectives & need of infertility counseling:
– Informed consent.
– To offer coping strategies to couples.
– To facilitate decision making.
– To offer preparation for procedures.
– To help client in achieving a better quality
of life.
– To provide genetic counseling.
Counseling Services:
– IVF- group discussion by staff.
– Third party reproduction for both donors
& recipients.
– Therapeutic counseling.
– Crisis counseling.
– Assessment & Follow-up.
Advantages of infertility counseling:
– Helps to deal with the emotional stress.
– Provide extra support.
– Allow the client in exploring all possible
options for family.
– Help the couples in overcoming the
dilemmas & deciding the right fertility
treatment.
– Explains about the infertility management
& specific treatment.
Role of Nurse in Infertility counseling:
– Receiving the patient & family, and make
them accessible & comfortable for
counseling.
– Fertility nurse specialists provide care for
the individuals and couples before, during,
and after fertility treatment.
– Nurse need to obtain history as prenatal,
family and other relevant history.
– Performing inseminations.
• Developed in 1992.